Sen. Susan Collins was astonished to learn that some pharmacists are “gagged” from being able to tell customers they can save money by paying cash for their prescriptions, instead of relying on their insurance and making the co-payment.
Now Ms. Collins, Maine Republican, is leading a push in Congress to change the practice, with her bill to forbid so-called “gag clauses” clearing the Senate Health Committee on Wednesday.
It’s another area of bipartisan agreement on health care even as Republicans and Democrats remain deeply opposed on the bigger questions surrounding Obamacare.
Ms. Collins said too many Americans are overpaying, because pharmacists can only divulge the cheaper option if the customer specifically asks about it.
“This is so counterintuitive — that using your debit card would be less expensive than using your insurance card to buy your prescription drug — that very few consumers are going to pose that question,” the senator said.
Ms. Collins drafted her bill after she watched a couple walk out of a Bangor, Maine, pharmacy without their medication, because their copay was too expensive. Home-state pharmacists also prodded her to act.
“They were so upset that they were unable to disclose this information,” Ms. Collins said.
Her bill applies to customers who hold insurance through a private employer or one of Obamacare’s exchanges. A separate bill before the Senate Finance Committee would apply the protections to seniors who rely on Medicare.
The Pharmaceutical Care Management Association (PCMA), a trade group for pharmacy benefit managers (PBMs) that have been blamed for the gag clauses, said it supports the legislation because it “aligns with standard practice” in the industry and will ensure that customers get the lowest price possible.
Major PBMs say they’ve already made changes, but bill sponsors say they’re still hearing from pharmacists that it’s going on.
They also pointed to a 2016 industry survey that said nearly 20 percent of pharmacists were forced to hold back information due to gag clauses at least 50 times per month.
President Trump called on Congress to stamp out gag clauses when he rolled out his drug-pricing plan in May.
Sen. Claire McCaskill, Missouri Democrat, facing re-election in a Trump-friendly state, co-sponsored the Collins bill, and it cleared on a unanimous voice vote, proving both sides can agree on at least one aspect of health care reform.
Still, Democrats say Mr. Trump should take more aggressive steps to drive down costs and reconsider his push to ban Title X-funded clinics from referring women to abortion services.
“I hope we can find bipartisan support to oppose that gag rule as well,” said Sen. Patty Murray, Washington Democrat.
Also Wednesday, the House tried to rein in costs by voting, 242-176, to freeze Obamacare’s tax on insurers through 2020, while expanding access to cheaper “copper” plans under the law’s exchange marketplaces and broadening the reach of tax-advantaged savings accounts for medical costs.
Though Democrats are reluctant to make changes to their 2010 health care law, some have said they don’t want insurers to pass along the costs of their tax in the form of higher premiums, so 12 supported the bill from Rep. Peter Roskam, Illinois Republican.
Others cried foul over expanding health savings accounts, saying they amount to a “tax shelter” for the well-heeled.
Democrats also said the latest moves won’t fix Mr. Trump’s effort to chip away at Obamacare by gutting its mandate to hold insurance, starting in 2019, and authorizing cheaper options that will siphon people out of the Obamacare marketplace.
At the same time, Democrats are hoping that rising rates help them defeat Republicans this November.
A Kaiser Family Foundation poll released Wednesday found that 6 in 10 Americans will hold Mr. Trump and his GOP allies are responsible for any problems under Obamacare, since they’ve made changes to the law.
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